Summaries of health policy coverage from major news organizations

CAESAREANS: More Women Want Choice

Today's New York Times reports that "some doctors say that more women are asking for C-sections, even when they are not necessary." This trend has left some doctors "sharply divided on how to respond." Women request C-sections because they want to be able to schedule the time of delivery, fear the pain of childbirth or long-term consequences such as urinary incontinence or loss of sexual satisfaction that can occur due to pelvic organ damage. In addition, recent studies have questioned the safety of vacuum-assisted natural deliveries and vaginal deliveries following C-sections. However, most doctors are loathe to do a C-section without medical indications. Dr. Andrei Rebarber of the New York University Medical Center told a patient who requested a scheduled C-section that he would not perform the procedure. "I feel that it's unethical," he said. But, the Times reports, his patient "was surprised" that she didn't have the choice of a C-section. "It's my body," she said.

The Debate Continues The debate centers on questions of how risky C-sections are compared to vaginal deliveries and just how many C-sections are too many. A "consensus" of doctors believe that the 21% rate of C-sections in this country is too high, and the Department of Health and Human Services wants to lower the rate to 15% by 2000. Dr. Charles Lockwood of the American College of Obstetricians and Gynecologists, however, said, "The assumption that our C-section rate is too high is based on zero data." He said lowering the rate "may be dangerous." However, while natural delivery results in urinary incontinence or sexual dysfunction in a small percentage of women, mostly those who have undergone multiple births, C-sections carry a higher risk of infection and death. Dr. Vicki Seltzer, past president of the American College of Obstetricians and Gynecologists, said, "I'm astonished that any women would want to have a Caesarean unless there's a problem with the pregnancy or the labor." However, a survey of female obstetricians in London found that 31% would choose a C-section for themselves (Gilbert, 9/22).

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